Incidence and Outcomes of Sterile Multifocal Inflammatory Keratitis and Diffuse Lamellar Keratitis After SMILE

Reinstein, Dan Z.; Stuart, Alastair; Vida, Ryan S; Archer, Timothy J; Carp, Glenn I

doi:10.3928/1081597x-20181001-02

Cited by 24 publications

(15 citation statements)

References 42 publications

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“…Postoperative complications of SMILE are essentially the same as LASIK, however there are two areas where some small differences have been identified. The first is with DLK where a unique appearing sterile multifocal inflammatory keratitis can present after SMILE, which needs to be aggressively treated [114]. The second area is epithelial ingrowth, which can be more common due to the instrument implanting epithelial cells within the interface by the instruments through the small 2-mm incision.…”

Section: Refinements To Smilementioning

confidence: 99%

Refractive surgery beyond 2020

Ang

Gatinel

Reinstein

et al. 2020

Eye

Self Cite

106

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Refractive surgery refers to any procedure that corrects or minimizes refractive errors. Today, refractive surgery has evolved beyond the traditional laser refractive surgery, embodied by the popular laser in situ keratomileusis or 'LASIK'. New keratorefractive techniques such as small incision lenticule extraction (SMILE) avoids corneal flap creation and uses a single laser device, while advances in surface ablation techniques have seen a resurgence in its popularity. Presbyopic treatment options have also expanded to include new ablation profiles, intracorneal implants, and phakic intraocular implants. With the improved safety and efficacy of refractive lens exchange, a wider variety of intraocular lens implants with advanced optics provide more options for refractive correction in carefully selected patients. In this review, we also discuss possible developments in refractive surgery beyond 2020, such as preoperative evaluation of refractive patients using machine learning and artificial intelligence, potential use of stromal lenticules harvested from SMILE for presbyopic treatments, and various advances in intraocular lens implants that may provide a closer to 'physiological correction' of refractive errors.

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Section: Refinements To Smilementioning

confidence: 99%

Refractive surgery beyond 2020

Ang

Gatinel

Reinstein

et al. 2020

Eye

Self Cite

106

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show abstract

“…Diffuse lamellar keratitis (DLK) after SMILE has been reported to occur with an incidence of 0.45%. [ 64 ] It usually resembled the appearance following LASIK but may rarely present as a sterile multifocal inflammatory keratitis. However, topical steroid therapy resolved all reported cases of DLK, and in all cases, there were no sequelae and no adverse effect on refractive or visual outcome.…”

Section: Refractive Corneal Lenticule Extraction Complications and Managementmentioning

confidence: 99%

Advances in refractive corneal lenticule extraction

Fuest

2021

Taiwan Journal of Ophthalmology

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Refractive errors are the leading cause of reversible visual impairment worldwide. In addition to the desired spectacle independence, refractive procedures can improve quality of life, working ability, and daily working performance. Refractive corneal lenticule extraction (RCLE) is a relatively new technique, dependent only on a femtosecond laser (FS). This leads to potential benefits over laser-assisted in situ keratomileusis (LASIK) including a quicker recovery of dry eye disease, a larger functional optical zone, and no flap-related complications. SMILE, available with the VisuMax FS (Carl Zeiss Meditec AG, Jena, Germany), is the most established RCLE application, offering visual and refractive outcomes comparable to LASIK. SmartSight (SCHWIND eye-tech-solutions GmbH, Kleinostheim, Germany) and CLEAR (Ziemer Ophthalmic Systems AG, Port, Switzerland) are two new RCLE applications that received Conformité Européenne (CE) approval in 2020. In this article, we review refractive and visual outcomes, advantages, and disadvantages of RCLE and also report on the latest advances in RCLE systems.

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“…The efficacy, safety, predictability, and stability of SMILE have been supported by many clinical studies [1,2]. However, intraoperative and postoperative complications can still be observed [3][4][5][6][7]. The possible complications of SMILE surgery include suction loss, difficulty or inability to extract the lenticule, and abrasion or minor tears in the small incision [8,9].…”

Section: Introductionmentioning

confidence: 99%

Risk factors and incidence of suction loss during small incision lenticule extraction (SMILE) in 8493 eyes

Huang

Shen

et al. 2020

BMC Ophthalmol

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Background To report the incidence and risk factors of suction loss during small incision lenticule extraction (SMILE). Methods This retrospective comparative case control study included 8493 eyes of 4261 patients. Patients underwent SMILE surgery between January 2014 and September 2019 were included. Videos of suction loss were reviewed, and the direct causes of suction loss were noted. An independent samples t-test was used for comparisons between the suction loss group and the control group. A binary logistic regression model was used to determine the possible significant risk factors that might increase the likelihood of suction loss during SMILE surgery. Results Suction loss occurred in 31 (0.37%) eyes of 30 patients; 23 (74.2%) cases occurred in the right eye (the first operative eye) and 8 (25.8%) cases occurred in the left eye. Among the 30 patients, 23 (76.7%) were male and 7 (23.3%) were female. The incidence in the six consecutive years were 0, 2.13, 0.34, 0.24, 0.22, and 0.25%. Head and eye movements during surgery caused suction loss in 16 (51.6%) and 15 (48.4%) eyes, respectively. Comparison between the suction loss group and the control group showed that the first operative eye and male sex are at a significantly high risk for suction loss (p < 0.05). Conclusions The risk factors of suction loss were first operative eye and male sex. Head and eye movements due to patient anxiety are the most common direct causes of suction loss. Surgeon’s experience may help to reduce the incidence of suction loss. Preoperative education and better communication during surgery needs to be emphasized. Trial registration Retrospectively registered. ChiCTR-ORC-17011040. Registered 1 April 2017. Name of registry: The observation of clinical results after corneal refractive surgery. Data of enrolment of the first participant to the trial: 1 January 2014.

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Incidence and Outcomes of Sterile Multifocal Inflammatory Keratitis and Diffuse Lamellar Keratitis After SMILE

Cited by 24 publications

References 42 publications

Refractive surgery beyond 2020

Refractive surgery beyond 2020

Advances in refractive corneal lenticule extraction

Risk factors and incidence of suction loss during small incision lenticule extraction (SMILE) in 8493 eyes

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